Spontaneous Bacterial Peritonitis in Cirrhotic Patients with Ascites

Abstract

Background: Spontaneous bacterial peritonitis (SBP) is a severe and life-threatening complication in patients with liver cirrhosis and ascites, resulting from spontaneous infection of ascitic fluid without an identifiable intra-abdominal source. It affects approximately 10–30% of hospitalized cirrhotic patients and is associated with significant morbidity and mortality. The pathogenesis is primarily related to bacterial translocation due to increased intestinal permeability, small intestinal bacterial overgrowth, and impaired immune defenses. Despite advances in diagnostic and therapeutic strategies, SBP remains a major clinical challenge, particularly in the era of rising antimicrobial resistance. Recent epidemiological shifts have demonstrated an increasing prevalence of Gram-positive and multidrug-resistant organisms, especially in nosocomial settings, which complicates empirical antibiotic selection. Clinical presentation may be subtle or atypical, emphasizing the importance of routine diagnostic paracentesis in all cirrhotic patients with ascites. Diagnosis is mainly based on an ascitic fluid polymorphonuclear leukocyte count ≥250 cells/mm³, regardless of culture results. Early initiation of appropriate antibiotic therapy and adjunctive albumin administration significantly improves outcomes.